Effects of the Strong Hearts program at two years post program completion

Methods

The protocol was approved by Western Institutional Review Board (WIRB ID #20192395), and written informed consent was obtained from all participants before participation. The original study design including recruitment, as well as the demographics of the study population, was described previously [5]. All patients who previously completed the Strong Hearts Program (n=128) were contacted by clinic staff via phone, and information was recorded on a Microsoft Excel spreadsheet in preparation for data analysis. Patients were asked questions about recent procedures or events related to CVD diagnosis, specifically, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). Other nonrelated cardiovascular procedures or events were also recorded. All communication dates were recorded for documentation and verification. Procedures and hospital readmissions were cross-referenced with the hospital’s electronic medical records. Death records were searched for all patients who were not able to be reached via phone.

Results

One hundred and twenty patients (n=120) responded to contact for follow-up. Six patients were lost to follow-up, and two patients were deceased.

We saw a significantly lower all-cause readmission rate at 6 months, 1 year, and 2 years post-program completion compared to empirical data found in the literature. At 6 months after program completion, the observed readmission rate was 1.7 % compared to the expected rate of 50 %, χ²(1)=112.13, p<0.001 [7]. Observed all-cause readmission at 1 year post-program completion was 14.2 % vs. the expected 45 %, χ²(1)=46.09, p<0.001 [8]. Observed all-cause readmission at 2 years post-program completion was 20.0 % vs. the published rate of 53.8 %, χ²(1)=56.43, p<0.001 [9]. The observed subsequent PCI or the need for PCI at 2 years post-program completion was 1.7 % vs. the previously reported 57.74 %, χ²(1)=153.08, p<0.001 [1]. The observed subsequent CABG rates, or the need for CABG at 2 years post-ICR completion, was 6.7 % vs. the published rate of 13.4 % [1], which reflected a significantly lower rate, χ²(1)=4.62, p=0.032. The expected all-cause mortality rate at 2 years post-ICR completion was 23.4 % [3]. In comparison, we only saw a 1.6 % rate of all-cause mortality, which was significantly lower than expected, χ²(1)=34.13, p<0.001. See Table 1 for a goodness-of-fit analysis for each outcome considered.

Discussion

The previously published results of the Strong Hearts program have demonstrated significant positive outcomes in mitigating cardiac risk factors among CVD patients. Notably, these effects have persisted beyond the program’s completion, with a decreased risk of cardiovascular reoccurrences and mortality at up to 2 years post-program completion. Our findings regarding readmission rates for patients who completed CR have surpassed those documented in the existing literature, indicating the efficacy of our program approach.

Central to the success of the Strong Hearts program is its patient-centered approach to intensive lifestyle behavior modification, encompassing personalized dietary adjustments, medical exercise therapy, behavioral change, and health education. The program includes live, hands-on structured classes focused on functional medicine, nutrition, and quality of life. The program differs from existing ICR programs in the fact that less emphasis is placed on a strict one-size-fits-all diet, and more emphasis is placed on the patient’s metabolic, medical, and environmental needs. Through interactive cooking demonstrations and tailored nutrition education, particularly relevant to the demographic served in the southern United States, specifically Arkansas, the program equips patients with practical tools for sustained CVD improvement.

The program’s emphasis on individualized care, utilizing each patient’s unique medical profile and information, ensures the development of personalized programs that are realistic and feasible for long-term results.

Conclusions

The Strong Hearts program not only addresses immediate cardiac risk factors but also fosters longer-term health outcomes. The program has shown through this follow-up to reduce CVD reoccurrences while having improved all-cause readmissions and mortality significantly following CR completion compared to other CR programs. The demonstrated effectiveness in reducing readmission rates and mortality underscores the role of our program in positively impacting the progression of CVD in this population. As we continue to refine and expand our efforts, the Strong Hearts program remains dedicated to the commitment to have a positive impact on patient lives and to combat the pervasive threat of CVD in our state.